1. Follow a diet that keeps blood sugar stable.

We now know that dietary fat isn't nearly as dangerous as dietary carbs, which raise blood sugar quickly. The vast majority of your carbohydrates should come from fruits and vegetables-and hold the potatoes. (I'll be writing much more about this in upcoming issues.)

- Heart Health Tip -
Eliminate all wheat products for two weeks and see what a difference it makes. If it works as well as I predict it will, keep it up! Hidden wheat allergy is very common. But what's more important, most of the "bad" carbs include wheat. Chances are good that making this change alone will lower your triglyceride levels and also result in significant weight loss.

2. Eat breakfast every day.
   Make sure you include some protein. This helps keep your insulin and blood sugar levels balanced throughout the day. There's no excuse for "I don't have time." Grab a bar and go.
3. Exercise. The heart is a muscle.
   You need to exercise it by making sure it beats more frequently from exercise. A brisk 30-minute walk every day has been found to lower blood pressure, cholesterol and over-all risk of heart disease. Exercise also helps your muscles utilize glucose more efficiently, thus lowering your insulin levels.

(See Reference 1.)

4. Use heart-healthy supplements.
   The reason we get heart and blood vessel disease in the first place is free radical damage (oxidative stress) to blood vessel walls, which results in endothelial damage. This damage comes from blood sugar levels and insulin levels that are too high, a nutrient-poor diet, and emotional and environmental stress of all kinds. There are many, many antioxidant supplements that have been shown to have cardiovascular benefit. And all of them tend to work well together. There are a couple, however, that really deserve particular attention when it comes to creating heart health: tocotrienols and coenzyme Q10.
   
   
   • Start with a good foundation. Take a good multivitamin daily to combat the effects of oxidative stress.
   • Try tocotrienols. Tocotrienols are part of the vitamin E family of compounds. But compared with regular vitamin E, they are 40-60 times more powerful as antioxidants.

     Tocotrienols have a positive effect on all three of the major physical risk factors for coronary artery disease: total cholesterol levels; oxidation of low-density lipoprotein (LDL, or "bad" cholesterol); and the clumping of red blood cells that makes stroke more likely. Free radical damage (oxidative stress from poor diet, psychological stress, smoking, etc.) that accompanies LDL oxidation is particularly dangerous because it can cause serious injury to artery and vein walls.

     Tocotrienols lower cholesterol by promoting the natural degradation of an enzyme (HMG-CoA reductase) that controls your liver's breakdown of LDL cholesterol. This is the same enzyme that statin drugs affect, except that tocotrienols work through a different mechanism. For that reason, you can often lower your cholesterol with tocotrienols instead of statins. Most multivitamins don't have significant amounts of tocotrienols, so you have to add them. If you plan to use tocotrienols to lower cholesterol, take about 50 mg per day daily for a month, and then lower the dose to about 30 mg (2 capsules per day) thereafter.

     If you're already on a statin drug, add tocotrienols. Tocotrienols work synergistically with statin drugs, thus enhancing their effectiveness. Use about 30-55 mg per day.

   • Hold the aspirin. Take tocotrienols. Although taking a baby aspirin a day has been found to help thin the blood, tocotrienols do the same thing without the risks of GI bleeding. They decrease blood clotting or "stickiness" the same way aspirin does, by inhibiting the production of a potent coagulation factor known as thromboxane. As thinner, more freely-flowing blood is associated with the lower risk of stroke, heart attack, and transient ischemic attack, tocotrienols have also been shown to decrease platelet aggregation by as much as 15-30 percent, an effect equivalent to that of baby aspirin. (If you're already on aspirin, you can still take tocotrienols because they don't enhance the effect of aspirin significantly, if at all.)

   (See Reference 2.)

   • Boost your heart muscle strength with coenzyme Q10. Coenzyme Q10 (60-90mg/day) is a nutrient that improves the ability of the heart to pump, helps lower blood pressure, and improves congestive heart failure in those who already have heart disease. CoQ10 works as a co-factor in the cellular synthesis of adenosine triphosphate, the basic energy molecule that supports cell life.

   CoQ10 levels can be up to ten times greater in heart muscle than in other tissues because the heart beats all the time. CoQ10 levels are often depleted in women who take statin drugs because these drugs interrupt many of the body's biochemical pathways in the process of lowering cholesterol. For those who already have heart disease, the dose of CoQ10 can be much higher (300-400 mg/day).

   (See Reference 3).

5. Deal with your emotions constructively, not destructively.
   Chronic anger and hostility shut down the energy of the heart. But depression is also an independent risk factor for heart disease. Depression is often anger that is turned inward against yourself-while hostility is taking your anger out on others. Neither one of these is heart-healthy. Instead you want to learn the skills for dealing with anger. Anger is a message from your inner guidance telling you that you have lost status, that things haven't turned out the way you expected, or that you're being put down. You need to learn how to feel your anger fully, own it, and take action to change the circumstances that brought it up in the first place. This may require working with a therapist. But I'd also like to suggest that you listen to Louise Hay's Anger Releasing audio program, or read through the anger training in the following book: Skills Training for Treating Borderline Personality Disorder, by Marsha Linehan (The Guilford Press, 1993). Although Marsha Linehan developed her skill set to treat borderline personality disorder, the skills work for anyone who is trying to gain access to all of their wisdom. It's brilliant. So don't be put off by the title!

Warmly,

Christiane Northrup, M.D.

Further reading:

Visit the Women's Heart Health page, as well as the Nourishing Your Midlife Heart page in the Menopause section.

See Chapter 14, "Living with Heart Passion and Joy: How to Listen to and Love Your Midlife Heart," in The Wisdom of Menopause.

Anger Releasing, an audio program of visualization exercises by Louise Hay.

R E F E R E N C E S

1. Ishikawa-Takata, K., Toshiki, O., & Tanaka, H. (2003). How much exercise is required to reduce blood pressure in essential hypertensives: A dose-response study. Am. J. Hypertension, 16 (8), 629-633.
2. Newaz, M. A., & Nawal, N. N. (1999). Effect of gamma-tocotrienol on blood pressure, lipid peroxidation and total antioxidant status in spontaneously hypertensive rats (SHR). Clin. Exp. Hypertens., 21 (8), 1297-1313.

Qureshi, A. A., & Peterson, D. M. (2001). The combined effects of novel tocotrienols and lovastatin on lipid metabolism in chickens. Atherosclerosis, 156 (1), 39-47.

Qureshi, A. A., et al. (1997). Novel tocotrienols of rice brain modulate cardiovascular disease risk parameters of hypercholesterolemic humans. Nutr. Biochem., 8, 290-298.

Qureshi, A. A., et al. (1993). Tocotrienols: Novel hypocholesterolemic agents with antioxidant properties. In L. Packer & J. Fuch (Eds.), Vitamin E in health and disease (pp. 247-267). New York: Marcel Dekker.

Sen, C. K., Khanna, S., Roy, S., & Packer, L. (2000). Molecular basis of vitamin E action. Tocotrienol potently inhibits glutamate-induced pp60(c-Src) kinase activation and death of HT4 neuronal cells. J. Biol. Chem., 275 (17), 13049-13055.

Theriault, A., Chao, J. T., Wang, Q., Gapor, A., & Adeli, K. (1999). Tocotrienol: A review of its therapeutic potential. Clin. Biochem., 32 (5), 309-319.

3. Digiesi, V., et al. (1990). Effect of coenzyme Q10 on essential hypertension. Current Therapy Research, 47, 841-845.

Ghirlandi, G., et al. (1993). Evidence of plasma CoQ10-lowering effects by HMG-CoA reductase inhibitors: A double-blind, placebo-controlled study. J. Clinical Pharmacology, 33, 226-229.

Sinatra, S. (2000). Heart sense for women, 108. Washington, DC: Lifeline.

Sinatra, S. (1998). The coenzyme Q10 phenomenon. New Cannan, CT: Keats Publishing.

Singh, R. B., et al. (1999). Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J. Human Hypertension, 13 (3), 203-208.

Yamagami, T., et al. (1977). Study of coenzyme Q10 in essential hypertension. In K. Folkers & Y. Yamamura (eds.), Biochemical and clinical aspects of coenzyme Q10, vol. 1, 231-242. Amsterdam: Elsevier.

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